Author Archives: churchc

The construction and legitimation of workplace bullying in the public sector: insight into power dynamics and organisational failures in health and social care

Nursing Inquiry Online: 17 AUG 2014;   DOI: 10.1111/nin.12077

Health-care and public sector institutions are high-risk settings for workplace bullying. Despite growing acknowledgement of the scale and consequence of this pervasive problem, there has been little critical examination of the institutional power dynamics that enable bullying. In the aftermath of large-scale failures in care standards in public sector healthcare institutions, which were characterised by managerial bullying, attention to the nexus between bullying, power and institutional failures is warranted. In this study, employing Foucault’s framework of power, we illuminate bullying as a feature of structures of power and knowledge in public sector institutions. Our analysis draws upon the experiences of a large sample (n = 3345) of workers in Australian public sector agencies – the type with which most nurses in the public setting will be familiar. In foregrounding these power dynamics, we provide further insight into how cultures that are antithetical to institutional missions can arise and seek to broaden the debate on the dynamics of care failures within public sector institutions. Understanding the practices of power in public sector institutions, particularly in the context of ongoing reform, has important implications for nursing.

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Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports

Journal of Clinical Sleep Medicine Vol 10 no 8 pp 927-935;


To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS).

Search Methods

We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles.

Selection Criteria

Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided.

Data Extraction and Analysis

Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed.


Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant’s sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case.


SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority.

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Conducted electrical weapons within healthcare: a comprehensive use of force model

J. Healthc. Prot. Manage. 2014; 30: 47-56.

Healthcare settings are experiencing increased amounts of violent activity that are challenging to the health care security profession. There is difficulty in addressing this issue completely. Some of this difficulty is because of factors that include inexperienced and untrained clinicians and administrators that are often the decision-makers in the health care setting. As part of an effective solution, we propose that a security plan, including a comprehensive use of force program incorporating conducted electrical weapons, is a necessary and best-practice goal. This paper outlines the background of the problem and discusses the challenges we encountered in reaching this goal as well as the benefits we have discovered along the way. This paper will be beneficial to any healthcare security professional that is interested in enhancing or improving their current health care security use of force model to further counter the increasing violent activity in their respective healthcare setting.

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Cannabis Impaired Driving: An Evaluation of Current Modes of Detection

Canadian Journal of Criminology and Criminal Justice Volume 56, Number 2 / February 2014;  pp 219-240;  DOI:  10.3138/CJCCJ.2014.ES05

Due to the growing concern with motorists driving under the influence of drugs, the Canadian government has recently implemented legislation to tackle this issue. The new legislation compels drivers to submit to a series of tests, by a police officer, if/when a motorist is suspected of drug impairment. The aim of this paper is to present a review of scientific studies that have evaluated the effectiveness of three methods to detect cannabis use in motorists. These methods include the Drug Evaluation and Classification (DEC) Program, on-site oral fluid screening devices, and on-site urine screening devices. Only studies that included appropriate measures of reliability (i.e., sensitivity, specificity, and accuracy) were included in this review. Given their increasing reliability, on-site oral fluid devices appear to show the most promise for the detection of cannabis use in motorists. Despite the promising results, however, there is still a need to establish standard levels of impairment for cannabis, like the blood alcohol content (BAC) cut-off levels for alcohol, before these devices can be meaningfully utilized and implemented.

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MT-45, a new psychoactive substance associated with hearing loss and unconsciousness

Clinical Toxicology Vol. 52, No. 8 , Sep-Oct 2014;  pp 901-904 (doi:10.3109/15563650.2014.943908

Background. MT-45 (1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) is an opioid analgesic drug candidate developed in the 1970s that has recently been introduced as a new psychoactive substance (NPS) on the “recreational” drug market. We describe a case series of non-fatal intoxications associated with MT-45 within the Swedish STRIDA project.
Study design. Observational case series of consecutive patients with admitted or suspected intake of NPS presenting to hospitals in Sweden from November 2013 to February 2014.
Patients and methods. Blood and urine samples were collected from intoxicated patients presenting to emergency departments and intensive care units over the country. NPS analysis was performed by an LC–MS/MS multi-component method. Clinical data were collected when caregivers consulted the Poisons Information Centre and also retrieved from medical records.
Case series. Among nine intoxications where MT-45 was detected in the biological samples, four cases were indicated to only involve MT-45, while one or several psychoactive substances were found along with MT-45 in the others. All patients were men aged 17–32 years and they commonly presented with opioid-like adverse symptoms, such as unconsciousness and respiratory depression. Naloxone appeared to have utility in the treatment of MT-45 intoxication in several cases. Three patients complained of bilateral hearing loss that in one case persisted after two weeks.
Conclusion. MT-45 should be added to the growing list of harmful NPS causing life-threatening poisonings, and rapid actions taken to make it a controlled substance.

Effect of different breath alcohol concentrations on driving performance in horizontal curves

Accident Analysis & Prevention Volume 72, November 2014, Pages 401–410;  DOI: 10.1016/j.aap.2014.07.032

Driving under the influence of alcohol on curved roadway segments has a higher risk than driving on straight segments. To explore the effect of different breath alcohol concentration (BrAC) levels on driving performance in roadway curves, a driving simulation experiment was designed to collect 25 participants’ driving performance parameters (i.e., speed and lane position) under the influence of 4 BrAC levels (0.00%, 0.03%, 0.06% and 0.09%) on 6 types of roadway curves (3 radii × 2 turning directions). Driving performance data for 22 participants were collected successfully. Then the average and standard deviation of the two parameters were analyzed, considering the entire curve and different sections of the curve, respectively.

The results show that the speed throughout curves is higher when drinking and driving than during sober driving. The significant interaction between alcohol and radius exists in the middle and tangent segments after a curve exit, indicating that a small radius can reduce speed at high BrAC levels. The significant impairment of alcohol on the stability of speed occurs mainly in the curve section between the point of curve (PC) and point of tangent (PT), with no impairment noted in tangent sections. The stability of speed is significantly worsened at higher BrAC levels. Alcohol and radius have interactive effects on the standard deviation of speed in the entry segment of curves, indicating that the small radius amplifies the instability of speed at high BrAC levels. For lateral movement, drivers tend to travel on the right side of the lane when drinking and driving, mainly in the approach and middle segments of curves. Higher BrAC levels worsen the stability of lateral movement in every segment of the curve, regardless of its radius and turning direction. The results are expected to provide reference for detecting the drinking and driving state.

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Estimating BrAC from transdermal alcohol concentration data using the BrAC estimator software program

Alcoholism: Clinical and Experimental Research Volume 38, Issue 8, pages 2243–2252, August 2014;  DOI: 10.1111/acer.12478


Transdermal alcohol sensor (TAS) devices have the potential to allow researchers and clinicians to unobtrusively collect naturalistic drinking data for weeks at a time, but the transdermal alcohol concentration (TAC) data these devices produce do not consistently correspond with breath alcohol concentration (BrAC) data. We present and test the BrAC Estimator software, a program designed to produce individualized estimates of BrAC from TAC data by fitting mathematical models to a specific person wearing a specific TAS device.


Two TAS devices were worn simultaneously by 1 participant for 18 days. The trial began with a laboratory alcohol session to calibrate the model and was followed by a field trial with 10 drinking episodes. Model parameter estimates and fit indices were compared across drinking episodes to examine the calibration phase of the software. Software-generated estimates of peak BrAC, time of peak BrAC, and area under the BrAC curve were compared with breath analyzer data to examine the estimation phase of the software.


In this single-subject design with breath analyzer peak BrAC scores ranging from 0.013 to 0.057, the software created consistent models for the 2 TAS devices, despite differences in raw TAC data, and was able to compensate for the attenuation of peak BrAC and latency of the time of peak BrAC that are typically observed in TAC data.


This software program represents an important initial step for making it possible for non mathematician researchers and clinicians to obtain estimates of BrAC from TAC data in naturalistic drinking environments. Future research with more participants and greater variation in alcohol consumption levels and patterns, as well as examination of gain scheduling calibration procedures and nonlinear models of diffusion, will help to determine how precise these software models can become.

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